1414. Risk Factors for Acquisition of Carbapenem-resistant Klebsiella pneumoniae (KPC) in the Intensive Care Units of a New York City Tertiary Medical Center
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • Slide1.PNG (530.2 kB)
  • Background: Limited data are available regarding patient risk factors that may contribute to acquisition of KPC colonization in the ICU setting. Identification of these factors may provide unique opportunities to interrupt horizontal transmission.

    Methods: A case control study was conducted among ICU patients comparing 9 cases with documented acquisition of KPC colonization during the ICU hospitalization to 3 age matched (± 3 yrs) controls who did not acquire colonization. Cases were identified during routine weekly peri-rectal swab sampling and KPC PCR testing of all ICU patients. A case was defined as any patient that initially tested KPC (-) who then subsequently tested (+) during the ICU stay. Controls were chosen from patients that remained KPC (-) throughout their ICU stay. Patient demographic and clinical data were collected and evaluated via univariate and multivariate analysis. Investigated risk factors included exposure to upper or lower GI procedures, proton pump inhibitors, rectal tube use, ventilator use, invasive device use, antibiotic exposure, and length of hospitalization/ICU stay.

    Results: Cases and controls did not differ by gender, types of comorbidities and reasons for admission, except that cases were less likely to have cardiovascular disease (p=0.04) and were more likely to have palliative care/DNR status (p=0.04 and p= 0.02, respectively). Univariate analysis identified ICU stay ≥7days (p=0.05), current cefepime treatment (p=0.04), and contact isolation for another MDRO (p=0.01) as risk factors for acquisition. Multivariate analysis identified that current cefepime treatment exposure had a >12 fold increased risk of KPC acquisition (OR= 12.44 [95% CI 1.53-100.8]) after adjustment for ICU length of stay and MDRO status.

    Conclusion:

    1.       Acquisition of KPC colonization in the ICU typically occurred within two weeks of ICU admission (100% of newly colonized patients).

    2.       Active cefepime treatment was a significant risk factor for acquisition of KPC colonization among ICU patients.

    3.       Antibiotic stewardship activities targeting cefepime use in the ICU setting may be an important adjunct measure to control the prevalence of KPC colonization.

    4.       No other unique patient risk factors related to acquisition of KPC bowel colonization were identified.

    David Aguirre, BS1, Sharon Leung, MD2, Noelle Burton, MD3, Jacques Simkins, MD2 and Brian P. Currie, MD, MPH2, (1)Albert Einstein College of Medicine, Bronx, NY, (2)Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, (3)Montefiore Medical Center, Bronx, NY

    Disclosures:

    D. Aguirre, None

    S. Leung, None

    N. Burton, None

    J. Simkins, None

    B. P. Currie, None

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